Dog/puppy Adoption Application
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1
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3DOG/PUPPY ADOPTION APPLICATION
Date__________________
Animal_________________#___________
Breed_____________Sex_____Age______
Rimrock Humane Society
P.O. Box 834
Roundup, MT 59072
(406)‐323‐3687
(406)‐323‐1863 (FAX)
WELCOME TO THE RIMROCK HUMANE SOCIETY
We are happy that you have come to us to adopt a dog/puppy. We hope that we can be of service to you. To
help ensure that the animal you want will be best suited to you, your home and lifestyle, and that the animal
will be placed in an environment compatible with its needs, we ask your cooperation in filling out the
application. We hope you will agree that the animal’s welfare MUST be our foremost consideration. Upon
completion of this application, a staff member will discuss the adoption with you and answer any questions
you might have. We ask for your patience and cooperation. Thank you.
Name__________________________________Driver’s License________________
Name(s) of other adults in household_____________________________________
Street Address_______________________________________________________
City________________County______________State____________Zip__________
Mailing Address (if different from above)___________________________________
Email Address ____________________________________________________
Home Phone_____________________Work Phone___________________________
Place of Employment___________________________________________________
Who will be responsible for this animal? ___________________________________
Do you live in a: (circle one)
House
Apartment
Duplex
Mobile Home
Other_______________
Do you: Own
Rent
Live with parents, relative, or guardian ?
If renting, does your landlord/rental agency allow pets? _______________________
Landlord’s Name_____________________Landlord’s Phone #__________________
How long have you lived at your present address?____________________________
Do you anticipate moving within the next six months?_________________________
If you move sometime in the future, what will you do with your pets?____________
Do you have children at home?___________________Ages?___________________
Are they used to animals?_____________Is anyone allergic to animals?___________
Do all adult members of the household know that you plan to adopt a dog?_______
Why do you want this animal? (Please circle one or more of the following)
Companion Guard Dog Companion for the Kids
Watch Dog
Hunting Dog
Companion for Other Dog/Puppy
For Breeding
Stock Dog
Gift
Other________________________________________________________________
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